The quality of early relational health modifies the effect of early life stress on child emerging psychopathology

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Abstract Background Early relational health (ERH) is thought to buffer the association between early life stress (ELS) and child psychopathology, but limited work has directly tested this hypothesis. Objective We evaluate mother-infant emotional connection, a facet of ERH, as a buffer of combined and individual impacts of specific ELS exposures (maternal mental health and interpartner conflict) on child psychopathology. Methods Participants included mother-infant dyads (n=100) followed longitudinally in the COMBO cohort, a convenience sample recruited during the COVID-19 pandemic. ERH was assessed via a remote mother-infant face-to-face interaction at ~4mo postpartum coded for emotional connection. An ELS Index was estimated using measures of maternal self-reported postpartum anxiety, depression, stress, and inter-partner conflict. Mothers rated emerging signs of child psychopathology symptoms at 2-3yrs on the Child Behavior Checklist for Ages 1½−5 (CBCL/1½−5). Main and interactive effects of ELS and ERH on emerging signs of child psychopathology were tested in generalized linear models. Results Greater ELS Index scores were associated with a higher rate of emerging psychopathology symptoms (aRR=1.32, p<.001), but this association was moderated by a significant interaction between the ELS Index and emotional connection (aRR=0.99, p=.03), such that at higher levels of emotional connection, the association of ELS with child psychopathology symptoms was weaker (aRR=1.16, p <.001). Conclusion Parent-infant emotional connection may buffer the impact of ELS exposure in infancy on child emerging symptoms of psychopathology in toddlerhood, supporting efforts to invest in pediatric interventions that target ERH.

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